Mortality, severity, and hospital admission among covid-19 patients with acei/arb use: A meta-analysis stratifying countries based on response to the first wave of the pandemic

Ahmad A. Alamer, Abdulaziz S. Almulhim, Ahmed A. Alrashed, Ivo Abraham

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) is controversial for treating COVID-19 patients. We aimed to estimate pooled risks of mortality, disease severity, and hospitalization associated with ACEI/ARB use and stratify them by country and country clusters. Methods: We conducted a search in various databases through 4 July 2020 and then applied random-effects models to estimate pooled risks (ORp) across stratifications by country cluster. Clusters were chosen to reflect outbreak times (China followed by Korea/Italy, others subsequently) and mobility restrictions (China and Denmark/France/Spain with stricter lockdowns than the UK/US). Results: Overall analysis showed no increase in mortality; however, a statistical increase in mortality was seen in the US/UK cluster with ORp = 1.28 [95% CI = 1.04; 1.56] and a decrease in China with ORp = 0.65 [95% CI = 0.43; 0.96] and France with OR = 0.31 [95% CI = 0.14; 0.69]. Severity and hospitalization were not statistically significant in the analysis; however, several associations were seen in specific countries but not in country clusters. Conclusion: The country-cluster meta-analysis provided a reasonable explanation for COVID-19 mortality among ACEI/ARB users. The analysis did not explain differences in severity and suggested the involvement of other factors. Hospitalization findings among ACEI/ARB users may be considered informative as they may have been subjected to clinical decisions and hospital-bed availability.

Original languageEnglish (US)
Article number127
JournalHealthcare (Switzerland)
Volume9
Issue number2
DOIs
StatePublished - Feb 2021

Keywords

  • Angiotensin II receptor blocker
  • Angiotensin-converting enzyme inhibitor
  • Covid-19
  • Disease severity
  • Hospital admission
  • Mortality

ASJC Scopus subject areas

  • Health Informatics
  • Health Policy
  • Health Information Management
  • Leadership and Management

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